Some cat named Michael Porter who teaches at Harvard said one of the first utterly comprehensible things I've heard about the problem with American health care delivery. It's piecework.
Essentially the problem is this, the business model of healthcare incents doctors and specialists to become more specialized. A patient is not a patient, so much as a target of a set of procedures that are delivered by a group (not a team) of various professionals who all want to get their piece in. A patient is not a project whose success or failure matters in terms of on-time, to spec and under budget. Such concepts are not applied to patients.
The next time you see a television show or movie in which the doctor comes to the patient and reads the chart extensively, think about it this way. They have no idea who that patient is nor have they spoken to the other people who does. They see the chart and the chart dictates a plan of action - which means the doctor has to think up a new leg on their trip through the system.
"OK we're going to run some tests". Which means, I think I can make a referral to this other kind of specialist who heretofore has had nothing to do with you, but I can only get his attention of we give him the results from this new branch of treatment I'm going to queue you up for. You pay for the tests and you wait for the specialist to pay attention. You cannot, ever, get two doctors in the room looking at the same patient at the same time, unless it's surgery. The business model does not support a customer focused organization.
Bundled Payments means, pay a team for patient outcomes. Here's 40 thousand dollars and 12 days. The six of you get together and figure out how to get Sally healthy again. Put your heads together. If you get her out in six days, there's a bonus. If you don't spend all of the money, you can roll it over into a reserve account and use it when you get a more complicated patient.
It's about the insurance, sure, but it should be about patient outcomes, and right now hospitals in America are running off a system of incentives that are not about patient outcomes.
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